…Health is a state of complete physical, mental and social well -being and The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States. The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of diseases, especially communicable disease, is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active cooperation on the part of the public are of utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their peoples which can be fulfilled only by the provision of adequate health and social measures… (CONSTITUTION OF THE WORLD HEALTH ORGANIZATION) DRAFT TWELFTH WHO GENERAL PROGRAMME OF WORK draft for discussion by the regional committees in 2012 not merely the absence of disease or infirmity.
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…Health is a state of complete physical, mental and social well-being and
The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition.
The health of all peoples is fundamental to the attainment of peace and
security and is dependent on the fullest cooperation of individuals and
States.
The achievement of any State in the promotion and protection of health is
of value to all.
Unequal development in different countries in the promotion of health and
control of diseases, especially communicable disease, is a common danger.
Healthy development of the child is of basic importance; the ability to live
harmoniously in a changing total environment is essential to such
development.
The extension to all peoples of the benefits of medical, psychological and
related knowledge is essential to the fullest attainment of health.
Informed opinion and active cooperation on the part of the public are of
utmost importance in the improvement of the health of the people.
Governments have a responsibility for the health of their peoples which
can be fulfilled only by the provision of adequate health and social
measures…
(CONSTITUTION OF THE WORLD HEALTH ORGANIZATION)
DRAFT TWELFTH WHO GENERAL PROGRAMME OF WORK
draft for discussion by the regional committees in 2012
not merely the absence of disease or infirmity.
EXECUTIVE SUMMARY To be added
DRAFT FOR DISCUSSION BY THE 2012 REGIONAL COMMITTEES
This first draft of the twelfth general programme of work for the period 2014–2019 represents work in
progress. It is presented for discussion by the regional committees in 2012 and builds on the outline
framework presented in May 2012 to the Sixty-fifth World Health Assembly and the Executive Board
at its 131st session. Throughout the document, points where more work is needed or where new text
will be added are indicated in italics. A final chapter on resources will be added in the version
submitted to the Executive Board in January 2013.
In this draft, Chapter 1 provides a short review of the changing global context in which WHO is
working. Chapter 2 looks at some of the broad implications of this context, particularly their influence
on the direction of reform. Chapter 3 covers the programme and priority-setting aspects of reform. It
discusses the scope of each category; describes how cross-cutting issues will be handled; and reviews
each of the agreed priorities in turn. Chapter 4 deals with corporate services and enabling functions –
the sixth category. Chapter 5 then sets out the logic underpinning the results chain and a first draft of
results at impact and outcome level.
As for the World Health Assembly,1 the draft general programme of work is summarized in the
graphic on the following page (Figure 1).
1 Document A65/5 Add.1.
IMPACT
OUTCOMES
CORPORATE
SERVICES
Health
systems
Preparedness, surveillance
and response
CATEGORIES &
PRIORITIES
• Equity and social justice
• Global solidarity
• Gender equality
• Emphasis on countries and
populations in greatest need
• Multilateralism
• Due consideration to the
economic, social, and
environmental
determinants of health
• Science and evidence-based
• Public health approach
• Providing leadership
• Shaping the research agenda
• Setting norms and standards
• Articulating policy options
• Providing technical support and
building capacity
• Monitoring and health trends
Communicable
diseases
Noncommunicable
diseases
Promoting health through
the life course
• Leadership in health
• Country presence
• Management and administration
• Governance and convening
• Strategic policy, planning, management and resource
coordination
• Strategic communications
• Knowledge management
• Accountability and risk management
TWELFTH GENERAL PROGRAMME OF WORK 2014–2019 - DRAFT STRATEGIC OVERVIEW
• National health policies, strategies,
and plans
• Integrated people-centred services
• Regulation and access to medical
products
• Alert and response capacities
• Emergency risk and crisis
management
• Epidemic- and pandemic-prone
diseases
• Food safety
• Polio eradication
• Heart disease, cancers, chronic lung
diseases, diabetes (and their major risk
factors tobacco use, unhealthy diet,
physical inactivity, harmful use of alcohol)
• Mental health
• Violence and Injuries
• Disabilities (including blindness and
deafness), and rehabilitation
• Nutrition
• Maternal and newborn health
• Adolescent sexual and reproductive
health
• Child health
• Women’s health
• Healthy ageing and health of the elderly
• Gender and human rights mainstreaming
• Health and the environment
• Social determinants of health
MISSION
To act as the directing and coordinating authority on international health work, towards the objective of the
attainment by all peoples of the highest possible level of health as a fundamental right.
• HIV/AIDS; tuberculosis; malaria
• Neglected tropical diseases
(including vector-borne diseases)
• Vaccine-preventable diseases
• Internationally agreed
instruments
• WHO's comparative
advantage
• Current health situation
• Existence of evidence-based,
cost-effective interventions
• Needs of countries for WHO
support
Universal health coverage
Improved healthy life expectancy
Principles, values and fundamental approaches WHO's core functions Criteria for priority-setting
DECREASE RISK FACTORS
INCREASE ACCESS + COVERAGE
DECREASE MORTALITY & MORBIDITY
ELIMINATION / ERADICATION OF DISEASES
STRENGTHEN HEALTH SYSTEMS
BUILD RESILIENT SOCIETIES
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CHAPTER 1
SETTING THE SCENE
New political, economic, social and environmental realities
The Eleventh General Programme of Work, 2006–2015 was prepared in 2005 during a period of
sustained global economic growth. Despite a prevailing sense of optimism, the Eleventh General
Programme of Work characterized the challenges for global health in terms of gaps in social justice,
responsibility, implementation and knowledge.
Subsequent events have shown this analysis to be prescient: as the first decade of the twenty-first
century has progressed it has become increasingly apparent that, instead of shared prosperity,
globalization has been accompanied by widening social inequalities and rapid depletion of natural
resources. This is not to deny the benefits of globalization, which have allowed many countries
dramatically to improve their living standards. Rather, it is a function of the fact that globalization has
been superimposed upon pre-existing problems and inequities; that current policies and institutions
have failed to ensure a balance between economic, social and environmental concerns; and that, as a
result, the pursuit of economic growth has been too often seen as an end in itself.
As the decade progressed the world witnessed the most severe financial and economic crisis since the
1930s. The full consequences of this self-inflicted disaster, accompanied by sharp rises in the costs of
food, fuel and other assets, have yet to play out. Nevertheless, it is already apparent that it has
accelerated the advent of a new order in which sustained growth is now a feature of several emerging
and developing economies, and in which many developed countries struggle to maintain fragile
recoveries.
At the start of the second decade of this century around three quarters of the world’s absolute poor live
in middle-income countries. Moreover, many of these countries are becoming less dependent on (and
indeed no longer eligible for) concessionary finance. As a result, an approach to poverty reduction
based on externally-financed development projects is becoming rapidly outdated. In its place is a need
for new ways of working that support the exchange of knowledge and best practice, backed by strong
normative instruments, and which facilitate dialogue between states, the private sector and civil
society. At the same time, many of the world’s poorest people will remain dependent on external
financial and technical support. If present trends continue, it is likely that the greatest need – as well
as the focus of much traditional development support – will become increasingly concentrated in the
world’s most unstable and fragile countries.
The new century has also seen a transformation in the relative power of the state on one hand, and
markets, civil society and social networks of individuals on the other. The role of the private sector as
an engine of growth and innovation is not new. Governments retain the power to steer and regulate,
however it is now difficult to imagine significant progress on issues of global importance such as
health, food security, sustainable energy and climate change mitigation without the private sector
playing an important role. Similarly, in low-income countries, resource flows from foreign direct
investment and remittances far outstrip development support and, in the case of remittances, have
often proved to be more resilient in the face of economic downturn than aid income.
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Perhaps the most dramatic change results from developments in communications technology:
empowering individuals and civil society on a scale that was simply not foreseen at the beginning of
the decade. Social media have changed the way the world conducts business, personal relationships,
and political movements. They have transformed risk communication. Only 10% of the world’s poor
have bank accounts, however there are already some 5.3 billion mobile phone subscribers, making
much wider access to financial services a realistic prospect. At the same time, the rapid increase in
connectivity that has fuelled the growth of virtual communications has risks as well as advantages, not
least in terms of the potential vulnerability to disruption of the interconnected global control systems
on which the world has now come to depend.
This brief sketch suggests several risks, challenges and opportunities, many of which have direct
implications for global health:
• A continuing economic downturn with consequent decreases in public spending has
implications for all countries. At a macroeconomic level, austerity and low demand in the
OECD countries may have an impact on growth worldwide. Reductions in public spending
risk creating a vicious cycle with a negative impact on basic services, low health and
educational attainment and high youth unemployment. At the opposite end of the age
spectrum, those retiring from work face the spectre of impoverishment and ill health in old
age.
• By 2050, 70% of the world’s population will live in cities. Rapid unplanned urbanization is a
reality, particularly in low-income countries and emerging economies. Urbanization brings
opportunities for the provision of health services and the promotion of health, but also carries
direct threats and significant risks of exclusion and inequity. It also brings into play new
institutional actors – most notably powerful city administrations with resources that can be
tapped for better health. While migration between countries can offer benefits to both the
countries from which migrants leave and to those to which they migrate, this is by no means
guaranteed and many migrants are exposed to increased health risks in their search for
economic opportunity.
• Falling fertility in many developing countries and the demographic dividend that accrues
from a larger working population in proportion to the very young and very old has boosted
economic growth in many parts of the world. For many countries this presents a vital
opportunity, particularly in relation to adolescent health. Real potential to fuel the engine of
growth for the future will be lost in the absence of efforts to increase youth employment.
Recent events in different parts of the world have shown how chronic unemployment
combined with a lack of economic and political rights and any form of social protection can
link to outrage and uprising. More broadly, the long-term impact of the economic downturn in
both rich and poor countries puts the social contract between governments and their citizens
under ever-increasing pressure.
• The global environment is equally under pressure. Key planetary boundaries (such as loss of
biodiversity) have been surpassed; and others soon will be. In many parts of the world,
climate change will increasingly jeopardize the fundamental requirements for health,
including clean urban air, safe and sufficient drinking-water, a secure and nutritious food
supply, and adequate shelter. Competition for scarce natural resources will increase. Most
people and governments accept the scientific case for sustainable development. They
recognize too that health contributes to its achievement, benefits from robust environmental
policies and is one of the most effective ways of measuring progress. Nevertheless, progress
at global and national level in creating institutions and policies that are better able to ensure a
more coherent approach to social, environmental and economic policy has been
disappointingly slow.
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• Slow progress on sustainable development is just one of the many challenges for global
governance as countries with different national interests seek agreed solutions to shared
problems. Global groupings (such as the G20) with more limited or like-minded membership
offer a means of making more rapid progress on specific issues but lack the legitimacy
conferred by fully multilateral processes. Similarly in health, issue-based alliances, coalitions
and partnerships have been influential in making more rapid progress in relation to tackling
challenges such as child and maternal mortality and HIV, tuberculosis and malaria. It is
equally the case that reasonable solutions to the most complex problems (such as equitable
access to medicines) require well-managed intergovernmental negotiations to reach a fair deal
for all.
A changing agenda for global health
The last decade has seen greater political attention and funding for health translate into significant
progress in terms of health outcomes. Despite the challenges outlined above, public health can remain
in the ascendancy, providing that WHO and the governments with which it works adapt to new
demands and a changing agenda. Next draft to have additional points on achievements.
The changing agenda for global health is in part a consequence of epidemiological and demographic
change – particularly the ageing of populations. Increasingly, however, as this section will highlight,
the agenda evolves in response to other factors. These include the changing political, social and
economic context in which countries and communities address health challenges, and, significantly, a
growing understanding of the need for new approaches to promoting and protecting health that address
the determinants of ill-health, as well as its immediate biomedical causes.
Noncommunicable diseases
In the context of the epidemiological transition the growing importance of noncommunicable diseases
as a cause of mortality is not new. What has changed is the recognition of the enormity of the social
and economic consequences of a failure to act on this knowledge. It is evident that sums in the order of
US$ 11 billion spent now on cost-effective interventions can prevent over US$ 40 trillion-worth of
future damage to the world’s economies. Nevertheless, there remains a significant gap between
rhetoric and reality when it comes to concrete action and the allocation of resources.
Economic, social and environmental determinants
In part, the reason for this gap is that few of the potential solutions lie within the health sector alone.
While this is true of many health conditions, an analysis of the causes and determinants of
noncommunicable diseases points to a particularly wide and multi-layered range of inter-related
determinants. These range from exposure to environmental toxins, through diet, tobacco use, excess
salt and/or alcohol consumption and increasingly sedentary lifestyles, which in turn are linked to
income, housing, employment, transport, agricultural and education policies, which themselves are
influenced by patterns of international commerce, finance advertising, culture and communications. It
is possible to identify policy levers in relation to all of these factors individually, however,
orchestrating a coherent response across societies that results in better health outcomes at both national
and global level remains one of the most prominent challenges in global health.
Epidemiological and demographic transition
For many low- and middle-income countries the continuing epidemiological and demographic
transition imposes a complex burden: infectious diseases in tandem with chronic noncommunicable
disease and mental illness as well as injuries and the consequences of violence. Meanwhile, although
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falling rates of fertility and mortality offer potential benefits, as noted above, with population ageing
as a universal trend, the demographic window of opportunity will close quickly.
Unfinished business
Noncommunicable diseases occupy a more prominent role in the global health agenda, but they should
not replace the world’s attention to existing concerns. In terms of health outcomes there is much
unfinished business. Monitoring of the Millennium Development Goals highlights a rapid decline in
child mortality in some countries, but also reveals much slower progress in reducing maternal and
neonatal deaths. Progress on all health-related Millennium Development Goals – between and within
countries – is uneven and there is a need to continue to ensure progress against the current set of health
goals; to back national efforts with the advocacy work needed to sustain the necessary political
commitment and financial support; and to maintain levels of investment in national and international
systems for tracking results and resources.
Innovation and technology
Innovation is critical in an era of economic austerity. New technology holds many promises. Astute
use of information and communications technology can make health professionals more effective,
health care facilities more efficient, and people more aware of the risks and resources that can
influence their health. Social media can get messages to places and people beyond the reach of
traditional channels of communications. Progress in meeting many of the world’s most pressing health
needs requires new policy instruments and new medicines, vaccines and diagnostics. At the same time,
growing demand for the newest and the best contributes to rocketing costs. For these reasons, the
value of health technology cannot be judged in isolation from the health system in which it is used.
Electronic medical records can improve quality of care, with adequate safeguards to assure
confidentiality. Scientific progress, ethical conduct and effective regulation have to go hand in hand.
The fundamental challenge is to harness innovation, in both the public and private sector. Doing so
involves using incentives and the stewardship of resources in ways that ensure that technology
development is an ethical servant to the health needs of the world's poor. (Next draft: separate
innovation and technology, illustrate relevance of innovation to service delivery)
Health care systems: financial sustainability
Innovation also needs to influence the delivery of health care. In many developed economies health
care costs continue to rise faster than gross domestic product due to a combination of rising public
expectations, increasing costs of technology, a growing burden of noncommunicable diseases, and
ageing populations. In many countries, the net effect will be to threaten the financial sustainability of
health systems. Smart solutions are needed to sustain universal coverage where it has been achieved
and to make further progress where it has not. Without such changes, pressures on public funding are
likely to result in greater exclusion of those without financial means to access care. (Next draft: note
that solutions need to go beyond financing, link to innovation in health care.)
Health care systems: ensuring access
In contrast, the future of health systems in many low-income countries will be one in which current
challenges continue, with inadequate levels of unpredictable funding; with limited access to life-
saving technologies; with the continuing daily toll of unnecessary death and disability from
preventable causes; with pressure to deliver quick results taking precedence over the need to build
strong institutions; and with conflicting technical advice and increasing demands from a growing
diversity of partners. A common factor in all countries is the need for skilled health staff. Access to
adequate levels of training, professional development, material reward and a supportive working
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environment remain the only sustainable ways of overcoming the pressures within and between
countries that fuel shortages and mal-distribution of health staff.
Preparing for the unexpected
Shocks must also be anticipated, including those delivered by new and re-emerging diseases and from
conflicts and natural disasters. Such shocks are certain to continue, even though their provenance,
location, severity and magnitude cannot be predicted. Conflict and the population displacement that
follows especially affect the health of women and children, the elderly and other vulnerable groups.
Shocks are also likely in the economic environment. The first decade of the 21st century brought
increased attention and resources to health, but this trend is by no means certain to continue, especially
as other global challenges, such as food security and climate change, make equally compelling claims.
In addition, the impact of the financial crisis will continue to be felt, although the impact will vary
from one country to another. Sustaining levels of resources for health in countries will require
increased support from national budgets, a broader external funding base, innovative financing
mechanisms and continuing commitment from traditional donors.
The institutional landscape for global health
It is traditional to point to the growing complexity of the institutional landscape for global level health,
characterized by more partnerships, foundations, financial instruments, bilateral and multilateral
agencies and civil society engagement. It is important however to recognize that the foundations of the
global system rest at national level.
The changing role of ministries of health
The role of ministries of health in all countries is evolving. If health increasingly requires multisectoral
responses, as the agenda for global health suggests, then the role of the ministry of health must expand,
from a primary preoccupation with the provision and financing of health services, to becoming a
broker and interlocutor with other parts of government. Similarly, ministries need the capacity to steer,
regulate and negotiate with a wide range of partners in an increasingly complex environment. Civil
society, patient groups, other nongovernmental organizations and the private sector now play a role –
in all countries – as both provider of health services and producer of health technologies. In all
countries, managing relationships with ministries of finance, planning and the economy is essential if
health concerns are to be given due prominence. In countries that receive development support,
ministries of health must be able to manage the tensions inherent in an accountability to the people
through parliament as opposed to an accountability to external providers of finance.
Health and the global agenda
The World Health Assembly provides a forum for ministers of health to meet with each other, but until
recently there have been relatively few opportunities that bring ministers of health together with
ministers of finance, foreign affairs, development or other sectoral groups. Similarly, in forums that
deal with issues that have a major impact on health, such as trade, agriculture or the environment,
health itself is rarely a central concern. Three recent trends suggest ways in which this situation is
changing. First, the growing interest in health issues on the part of the United Nations General
Assembly, in which ministries of foreign affairs are the main participants. Second, the increasing
prominence of regional and subregional organizations that also bring together different sectoral groups.
Third, the power of non-state actors in civil society who increasingly insist that human health and
well-being be a central concern of global governance.
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Global goals post-2015
At present, health in part owes its prominent place in global discussions of development to its position
in the Millennium Development Goals. The debate about how the next generation of goals post-2015
should be determined and what their focus should be is already underway. One of the lessons of the
Millennium Development Goals is that the way goals and indicators are defined influences how the
world understands development. As a result, goals shape political agendas and influence resource
transfers. Ensuring that health has a place in the next generation of global goals thus becomes an
important priority. (Next draft: strengthen this section based on UN Task Team, H8 report and
thematic health consultations.)
Engagement with other stakeholders
In contrast to the situation in most countries where multiple interactions between government, civil
society and nongovernmental organizations are commonplace, the global health environment is more
fragmented. In part to ensure the integrity of the normative role of multilateral organizations such as
WHO, and to protect against the risk of vested interests influencing policy, global health governance
currently gives pride of place to intergovernmental processes. At the same time, given worldwide
changes in society and the potential health benefits of wider engagement and consultation,
constructive and principled engagement becomes increasingly important. Such engagement should not
undermine the role of governments in having the final say in determining policy, nor compromise the
integrity of normative standards and guidelines.
More effective development support
The greatest proliferation of new institutional actors in health has been in the area of providing and
financing development support. In a decade of rising donor contributions, a range of new partnerships
and alliances, financing channels and sources of technical support have emerged. There is little doubt
that the increase in the quantum of funds has made a significant difference to the achievement of the
Millennium Development Goals and targets, even if the multiplicity of donors has diminished overall
coherence. In the coming decade, there is little doubt that the development architecture will be
changed in fundamental ways by the combination of: financial recession in many donor countries,
with attendant concerns for fiduciary accountability; sustained growth in many other economies, with
decreasing need or eligibility for aid; the growing role of donors from large emerging economies,
particularly as financiers of major infrastructure; the shift in development thinking from the Paris
Declaration on Aid Effectiveness, through the Accra Agenda for Action to the current Busan
Partnership for Effective Development Cooperation, with its focus on South-South and other forms of
cooperation. While the precise direction of change is currently unclear, the need will remain for
agencies such as WHO to help Member States manage complexity, as will the need to make sure that
country experience informs the global debate, and vice versa. 1
Health and security
The world’s principal defence against surprises arising from the microbial world (and increasingly the
interface between humans and animals – the source of 75% of new diseases) continues to come from
the systems and programmes that gather real-time intelligence about emerging and epidemic-prone
1 The Partnership for Effective Development Cooperation agreed in Busan, Republic of Korea in December 2011
reflects these changes: “We have a more complex architecture for development co-operation, characterized by a greater
number of state and non-state actors, as well as cooperation between countries at different stages in their development, many
of them middle-income countries. South–South and triangular cooperation, new forms of public-private partnership, and
other modalities and vehicles for development have become more prominent, complementing North-South forms of
cooperation.”
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diseases, that verify rumours, issue early alerts, and mount an immediate international response aimed
at containing the threat at its source. The pandemic (H1N1) 2009 confirmed that the International
Health Regulations (2005) is the key legal instrument to achieving collective security against
microbial and all other threats that can cause public health emergencies of international concern.
Nevertheless, the 2011 report of the Review Committee on the functioning of the International Health
Regulations (2005) in relation to pandemic (H1N1) 2009 concluded that the world is still ill-prepared
to respond to a severe pandemic or to any similarly global, sustained and threatening public health
emergency. Ensuring that countries put in place the systems required to conform with the International
Health Regulations (2005) is key to ensuring that all links are in place in the chain of surveillance and
response to major public health events. Associated with this is the need to reduce the health and
economic consequences of foodborne diseases. The International Food Safety Authorities Network,
INFOSAN, operates as the investigative arm of efforts to protect the safety of the food supply. This
work becomes all the more important given the growing intricacies of the global food trade and the
complexity of identifying products that may have entered international trade.
The transformative agenda for major humanitarian action
Decisions made in the immediate aftermath of a large-scale sudden-onset emergency are critical in
determining the effectiveness of the humanitarian response. Some of the mega-disasters in recent years
have highlighted weaknesses in the multilateral humanitarian response. The “Transformative Agenda”
agreed by the principals of the agencies that make up the Inter-Agency Standing Committee (IASC)
provides a way of ensuring a collective system-wide response. Principals will meet within 48 hours of
a crisis to define the scale of an emergency. If a Level 3 emergency is declared this will trigger a
collective response from all IASC agencies, including the deployment of the most senior levels of
overall field leadership and the leadership of key clusters such as health. The revision of the 2005
Hyogo Framework for Action in 2015 affords a further opportunity to increase the efficiency of the
humanitarian system.
Relief and development
Until recently humanitarian systems have operated separately from those dealing with public health
emergencies. Increasingly, it is recognized that a more holistic response to emergency risk
management is required that integrates prevention, emergency risk reduction, preparedness,
surveillance, response and recovery. This approach is now being reflected in the way that WHO
organizes its work. Furthermore, experience demonstrates that the distinction between relief and
development is artificial – and that the separation of related programmes can be counterproductive.
The increasing frequency of disasters, partially driven by factors such as climate change and rapid
urbanization, requires that they be expected and planned for. Moreover, the transition from
humanitarian action to development is rarely linear. At least one fifth of humanity lives in countries
experiencing ongoing violence and conflict that contributes to insecurity. Countries affected in this
way have higher rates of poverty and most have yet to achieve a single Millennium Development Goal.
To build greater resilience requires investment in the political institutions that help create stability, a
focus on preparedness through emergency risk management, and the recognition that relief and
development are deeply interdependent.
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CHAPTER 2
THE ROLE OF WHO
WHO has been at the forefront of improving health around the world since its founding in 1948. As
Chapter 1 has shown, the challenges confronting public health have changed in profound ways and
with exceptional speed. The overall purpose of the WHO programme of reform is to ensure that WHO
evolves to keep pace with these changes.
Chapter 2 examines some of the broad implications of the changing context for the work of WHO.
Reform, in terms of programmes and priorities, is covered in Chapter 3, and in relation to governance
and management reform in Chapter 4.
Enduring principles, values and approaches
WHO remains firmly committed to the principles set out in the preamble to the Constitution (as set out
in Box 1). These principles are also reproduced on the cover page of this document.
Box 1. Constitution of the World Health Organization: principles
Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.
The enjoyment of the highest attainable standard of health is one of the fundamental rights of
every human being without distinction of race, religion, political belief, economic or social
condition.
The health of all peoples is fundamental to the attainment of peace and security and is
dependent on the fullest cooperation of individuals and States.
The achievement of any State in the promotion and protection of health is of value to all.
Unequal development in different countries in the promotion of health and control of
diseases, especially communicable disease, is a common danger.
Healthy development of the child is of basic importance; the ability to live harmoniously in a
changing total environment is essential to such development.
The extension to all peoples of the benefits of medical, psychological and related knowledge
is essential to the fullest attainment of health.
Informed opinion and active cooperation on the part of the public are of utmost importance in
the improvement of the health of the people.
Governments have a responsibility for the health of their peoples which can be fulfilled only
by the provision of adequate health and social measures.
In a context of growing inequity within and between countries, competition for scarce natural
resources, and a financial crisis that threatens basic entitlements to health care, it would be hard to find
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a better expression of health as a fundamental right, as a prerequisite for peace and security, and the
key role of equity, social justice, popular participation and global solidarity in the Organization’s work.
It is also important in the context of the draft general programme of work to re-state key elements of
the approach that WHO adopts to its constitutional role as the independent guardian and monitor of
global and regional health status.
• In line with the principle of equity and social justice, WHO will continue to give emphasis
where needs are greatest. Whilst WHO’s work will continue to be relevant to all Member
States, the Organization sees health as being central to poverty reduction. The analysis in
Chapter 1 points to the fact that the greatest absolute number of poor people are now citizens
of middle-income and emerging economies. The focus is therefore not only on countries, but
on poor populations within countries.
• WHO is and will remain a science and evidence-based Organization with a focus on public
health. The environment in which WHO operates is becoming ever more complex; however
WHO’s legitimacy and technical authority lies in its rigorous adherence to the systematic use
of evidence as the basis for all policies. This also underpins WHO’s core function of
monitoring health trends and determinants at global, regional and country level.
• The review of health governance issues points to the need for negotiated solutions to shared
international health problems, particularly in instances of interaction between health and other
sectoral interests (such as trade, migration, security and intellectual property). In addition, the
capacity to convene and facilitate the negotiation of binding international agreements
distinguishes WHO from most other health actors. A commitment to multilateralism remains
a core element of WHO’s work .
• WHO will continue to be both a normative agency that produces a range of guidelines, norms
and standards that benefit countries collectively, as well as a provider of technical support to
individual Member States.
• As a public health agency, WHO continues to be concerned not with the purely medical
aspects of illness, but with the promotion of health as a positive outcome of all policies.
A strategic response to a changing environment
Addressing the social, economic and environmental determinants of health
As the Constitutional principles make clear, WHO is an Organization that is concerned with
the promotion of good health, not just the prevention and treatment of disease. The situation
analysis and the challenges to global health demonstrate the importance of this role. Moreover,
while a concern for health as an outcome of all policies in other sectors and the broader
economic, environmental and social determinants are not new in themselves, the High-level
Meeting of the General Assembly on the Prevention and Control of Non-communicable
Diseases in September 2011, the Commission on Social Determinants, and the World
Conference on Social Determinants of Health in October 2011 gives this area of work
renewed emphasis and momentum.1 The “cross-cutting issues” section of Chapter 3 below
1 The Political Declaration at the World Conference identified five action areas in which WHO was requested to support
Member States:
1. Improved governance for health and development
2. Participation in policy-making and implementation.
3. Reorientation of the health sector towards promoting health and reducing health inequities.
4. Global Governance and collaboration.
5. Monitoring progress and increasing accountability
NOT MERELY THE ABSENCE OF DISEASE
GPW12 draft for regional committees
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provides more detail on how work on the social determinants of health will be reflected in all
the categories in successive programme budgets.
Adjusting to a new financial reality Most analysts now suggest that the financial crisis will have long-term consequences, and not
only in the OECD countries that provide a large proportion of WHO’s voluntary funding. It is
therefore evident that WHO needs to respond strategically to a new, constrained financial
reality rather than respond managerially to a short-term crisis. The response has a number of
elements. At a programmatic level, as this general programme of work highlights, the need is
for priorities to be agreed by Member States so that countries define what is important rather
than donors alone. Priorities need to be linked to a hierarchy of measurable outcomes and
outputs, so that the tangible benefits of an investment in WHO are clear to as wide an
audience as possible. Accountability linked to transparent, objective and timely reporting of
results is needed not just for WHO as a whole but all its constituent parts. The current
financial environment is one of uncertainty; measures to increase predictability of WHO’s
financing and thereby facilitate realistic planning and budgeting, are therefore essential.
Integrated health services
Paragraph to be added on the shift away from categorical disease-focused programmes
towards greater health service integration reflecting concerns for more people-centred
services as well as efficiency and value for money. Key points: integration across whole
health care continuum from primary prevention through acute management to rehabilitation;
links between medical, social and long-term care; key benefits in terms of noncommunicable
diseases; links between maternal and child health and associated health impact; ageing
populations.
Health governance: the role of WHO
The review of the institutional landscape highlights the need for WHO to broaden its health
governance role. Traditionally, this role has been seen primarily in terms of convening
countries to negotiate solutions for shared problems at both headquarters and regional level to
produce conventions, regulations, resolutions, and technical strategies. While this role remains a key part of the Organization’s business, there are many new challenges to be
addressed, not just at headquarters but at country and regional level.
At country level, WHO’s role is in support of national authorities, facilitating the development
of national policies and strategies around which other partners align; ensuring that health is
well positioned and coordinated in the work of the United Nations country team; and where
national governments are disabled by conflict or disaster, WHO fulfills a similar role as
coordinator of the health cluster in emergencies. Strengthening country offices to fulfill these
roles is discussed in more detail in Chapter 4.
In the changing landscape regional and subregional integration is a growing trend. It is
therefore important that health is well-represented. Given the many actors involved, WHO’s
regional offices have a vital role to play in terms of coordination and direction. A growing
network of relationships beyond the regional committees will ensure links between ministries
of health and WHO regional committees, regional United Nations bodies, and a range of
regional political, economic and development organizations.
At a global level, governance for health is also understood in terms of how other inter-